| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| AP BENEFITS ADVISORS LLC3 Filed as: AP BENEFITS ADVISORS, LLC | STE 200 200 INTERNATIONAL CIR HUNT VALLEY, MD 21030 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $34 | $0 | $34 | 2.38% |
| MARSH & MCLENNAN AGENCY LLC3 Filed as: TRION GROUP, INC. A MARSH MCLENNAN | 2300 RENAISSANCE BLVD KING OF PRUSSIA, PA 19406 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $4 | $0 | $4 | 0.28% |
| MALLY, BRIAN, LEE3 | 1543 WICKERTON DR WEST CHESTER, PA 19382 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $3 | $0 | $3 | 0.21% |
| AP BENEFITS ADVISORS LLC3 Filed as: AP BENEFITS ADVISORS, LLC | 21 E 5TH ST STE 204 CONSHOHOCKEN, PA 19428 | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | $1 | $0 | $1 | 0.07% |
| AP BENEFITS ADVISORS LLC3 Filed as: AP BENEFITS ADVISORS | 200 INTERNATIONAL CIR, STE 4500 HUNT VALLEY, MD 21030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $122 | $0 | $122 | 14.97% |
| AP BENEFITS ADVISORS LLC3 Filed as: AP BENEFITS ADVISORS | 200 INTERNATIONAL CIR, STE 4500 HUNT VALLEY, MD 21030 | HIGHMARK, INC | $39 | $0 | $39 | 5.83% |
| AP BENEFITS ADVISORS LLC3 Filed as: AP BENEFITS ADVISORS | 200 INTERNATIONAL CIR, STE 4500 HUNT VALLEY, MD 21030 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $35 | $0 | $35 | 9.94% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| THE BENECON GROUP, LLC EIN 23-1315351 BROKER | Insurance agents and brokers Service code 22 | — | $2K |
| AP BENEFIT ADVISORS, LLC BROKER | Insurance agents and brokers Service code 22 | 200 INTERNATIONAL CR STE 4500 HUNT VALLEY, MD 21031 | $2K |
| CAPITAL BLUE CROSS EIN 23-0455154 ADMIN | Claims processing Service code 12 | — | $2K |
| CONNECTCARE 3 EIN 26-1768616 PATIENT ADVOCATE | Other services Service code 49 | — | $306 |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 40 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 40 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | STANDARD INSURANCE COMPANY | 0 | $0 |
| Vision | HIGHMARK, INC | 26 | $669 |
| Life insurance(2 contracts) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 44 | $1K |
| Stop-loss / reinsurancereinsurance | EVEREST REINSURANCE COMPANY | 30 | $13K |
| Other(3 contracts, 2 carriers) | PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY | 44 | $3K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 44 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.